Litigation Overview

The Plaintiffs: Rosie D. is the lead named plaintiff in a class action lawsuit that sought to compel the Commonwealth of Massachusetts to provide intensive home-based mental health services to children with serious emotional disturbance (SED).The Center for Public Representation, the Mental Health Legal Advisors Committee and Wilmer Cutler Pickering Hale and Dorr LLP filed the lawsuit in 2001 on behalf of Rosie D. and eight other Medicaid-eligible children, aged 6 to 15, who were hospitalized or at risk of hospitalization due to the lack of home-based services.The class includes tens of thousands of children in Massachusetts who are eligible for Medicaid (MassHealth) and have emotional, behavioral or psychiatric disabilities.

The Legal Claims:The plaintiffs challenged the State’s failure to provide medically necessary services as required under the federal Medicaid Act, and its failure to inform parents and children that they are entitled to these covered services. Under Medicaid’s Early and Periodic Screening, Diagnosis and Treatment(EPSDT) mandate, all States must screen eligible children, diagnose conditions found through a screen, and furnish appropriate treatment to correct or ameliorate physical and mental illnesses. The services must be provided promptly and for as long as needed.

The Trial:The case was tried in the spring of 2005 in the United States District Court, Western Massachusetts Division, before Judge Michael A. Ponsor.Over the course of the six-week trial, more than 30 witnesses testified about the effectiveness of home-based services, the State’s failure to provide these services, the thousands of children who need these services, and the harm they suffer when denied this treatment.

The Decision: On January 26, 2006, Judge Ponsor handed down a 98-page decision that found that the Commonwealth violated the EPSDT provisions of the federal Medicaid Act by failing to provide home-based services to thousands of children across the state.“The result of this failure is that thousands of Massachusetts children with serious emotional disturbance are forced to endure unnecessary confinement in residential facilities or to remain in costly institutions far longer than their medical conditions require,” the judge stated.

The Remedy:Judge Ponsor approved a Remedial Plan in February 2007 that seeks to restructure the children’s mental health system by incorporating intensive home-based services, including behavioral health screenings, assessments, case management, crisis intervention and in-home therapeutic supports.The Plan, which has strict timelines, must be implemented by July 1, 2009.A Court Monitor oversees the implementation, mediates disputes between the parties and ultimately will determine compliance with the Court’s Order.